De Portal da Codificação Clínica e dos GDH

9352

Tabela de conteúdo

Considerandos

Chronic total occlusion of an artery in the extremities will generally develop over a long time period, with partial occlusion present initially. This can cause symptoms such as intermittent claudication (leg pain with exercise), when arteries to the lower extremities are involved. With worsening of a partial occlusion, rest pain may develop. On the other hand, presence of collateral blood supply may allow worsening of an occlusion with relatively less symptoms.

A more acute presentation of a total occlusion of a peripheral artery would usually result in an arterial thrombosis. This would be coded to category 444 Arterial embolism and thrombosis. These cases will involve sudden onset of severe pain. Treatment options include medical treatment with anticoagulation and thrombolytic therapy, and surgical treatment with thrombectomy, angioplasty, and bypass surgery.

A chronic total occlusion is typically composed of a hard fibrotic proximal cap, which may be calcified. This is followed by a segment of poorly organized fibrous and calcified plaque, ending with a firm distal cap. Symptoms for a chronic total occlusion may vary, particularly in relation to the significance of collateral blood supply. Treatment with stenting or angioplasty would be significantly more complex and difficult than for cases where there was only a partial occlusion, since the total occlusion is harder to cross. A chronic total occlusion of a native artery of the extremities would be coded to subcategory 440.2.

This proposal gives options to create a specific code(s) for chronic total occlusion of native artery of the extremities, paralleling the codes at subcategory 440.2. The proposal is based on a request from Cordis that the ICD-9-CM diagnosis codes be revised to allow for more specific coding of chronic total occlusion of arteries of the extremities.

Proposta

Tabular modifications

Option 1

440 Atherosclerosis

440.2 Of native arteries of the extremities

Use additional code for chronic total arterial occlusion of the extremities (440.4) (Add)

440.4 Chronic total arterial occlusion of the extremities (New code)

Code first atherosclerosis of native arteries of the extremities (440.20-440.29)

Option 2

440 Atherosclerosis

440.2 Of native arteries of the extremities

Excludes: chronic total occlusion of native artery of the extremities (440.4) (Add)

440.4 Chronic total occlusion of native artery of the extremities (New subcategory)

Excludes: atherosclerosis of bypass graft of the extremities (440.30-440.32)

440.40 Chronic total occlusion of native artery of the extremities, unspecified (New code)

440.41 Chronic total occlusion of native artery of the extremities with intermittent claudication (New code)

440.42 Chronic total occlusion of native artery of the extremities with rest pain (New code)

Any condition classifiable to 440.41

440.43 Chronic total occlusion of native artery of the extremities with ulceration (New code)

Any condition classifiable to 440.21-440.22

Use additional code for any associated ulceration (707.10 - 707.9)

440.44 Chronic total occlusion of native artery of the extremities with gangrene (New code)

Any condition classifiable to 440.21, 440.22, and 440.23 with ischemic gangrene 785.4

Use additional code for any associated ulceration (707.10 - 707.9)

Excludes: gas gangrene 040.0

440.49 Other chronic total occlusion of native artery of the extremities (New code)